Healthcare-associated infections and their prevention after extensive flooding.

Purpose Of Review: This review will focus on the epidemiology of healthcare-associated infections (HAIs) after extensive blackwater flooding as well as preventive measures.

Recent Findings: There is evidence suggesting an increased incidence of HAIs and pseudo-outbreaks due to molds after extensive flooding in healthcare facilities. However, there is no strong evidence of an increased incidence of typical nosocomial infections (i.

Five-year outbreak of community- and hospital-acquired Mycobacterium porcinum infections related to public water supplies.

Mycobacterium porcinum is a rarely encountered rapidly growing Mycobacterium (RGM). We identified M. porcinum from 24 patients at a Galveston university hospital (University of Texas Medical Branch) over a 5-year period.

Epidemiology of methicillin-susceptible Staphylococcus aureus in a university medical center day care facility.

Background: Few data are available on methicillin-susceptible Staphylococcus aureus (MSSA) colonization in day care. We performed a study in a child care center on a medical university campus to study the epidemiology of MSSA in this population.

Methods: A cross-sectional study was done on 104 day care attendees and 32 adult employees of the child care center.

Epidemiology of methicillin-resistant Staphylococcus aureus in a university medical center day care facility.

Objective: Few data are available on methicillin-resistant Staphylococcus aureus (MRSA) colonization in day care. We performed a study in a medical university child care center to study the epidemiology of MRSA in this population.

Design: Survey.

A changing pattern of infection after major vascular reconstructions.

Wound and graft infection can occur in more than 40% of patients undergoing vascular reconstructions for peripheral arterial disease (PAD). A recent increase in the frequency and severity of infections, as well as a change in the microorganisms recovered, led us to undertake a retrospective case-controlled study of wound/graft infections at this institution. The medical records of all patients undergoing vascular reconstruction for PAD during the previous 36 months were reviewed.

The epidemiology of burn wound infections: then and now.

Burn wound infections are a serious complication of thermal injury. Although pneumonia is now the most important infection in patients with burns, burn wound infection remains a serious complication unique to the burn recipient. The methods for managing thermal injury have evolved during the past 50 years.

Effect of gastrointestinal bleeding and oral medications on acquisition of vancomycin-resistant Enterococcus faecium in hospitalized patients.

There has been minimal investigation of medications that affect gastrointestinal function as potential risk factors for the acquisition of vancomycin-resistant enterococci (VRE). We performed a retrospective case-control study, with control subjects matched to case patients by time and location of hospitalization. Strict exclusion criteria were applied to ensure that only case patients with a known time of acquisition of VRE were included.

Ventilator-associated pneumonia or not? Contemporary diagnosis.

Ventilator-associated pneumonia (VAP) is pneumonia in patients who have been on mechanical ventilation for > or =48 hours. VAP is most accurately diagnosed by quantitative culture and microscopy examination of lower respiratory tract secretions, which are best obtained by bronchoscopically directed techniques such as the protected specimen brush and bronchoalveolar lavage. These techniques have acceptable repeatability, and interpretation of results is unaffected by antibiotics administered concurrently for infection at extrapulmonary sites as long as antimicrobial therapy has not been changed for <72 hours before bronchoscopy.

Comparison of three methods to recover vancomycin-resistant enterococci (VRE) from perianal and environmental samples collected during a hospital outbreak of VRE.

Objective: To establish an efficient and sensitive technique for recovering vancomycin-resistant enterococci (VRE) from perianal and environmental samples collected during implementation of control measures for an outbreak of VRE.

Design: Perianal and environmental samples were collected in triplicate on sterile swabs. One swab was used to inoculate a selective broth medium containing 6 pg of vancomycin and 8 pg of ciprofloxacin per mL, one to inoculate Campylobacter agar containing 10 microg/mL of vancomycin, and one to inoculate Enterococcosel agar containing 8 microg/mL of vancomycin.

Clinical infection control in gene therapy: a multidisciplinary conference.

Gene therapy is being studied for the treatment of a variety of acquired and inherited disorders. Retroviruses, adenoviruses, poxviruses, adeno-associated viruses, herpesviruses, and others are being engineered to transfer genes into humans. Treatment protocols using recombinant viruses are being introduced into clinical settings.

Evaluation of fluorescence-based amplified fragment length polymorphism analysis for molecular typing in hospital epidemiology: comparison with pulsed-field gel electrophoresis for typing strains of vancomycin-resistant Enterococcus faecium.

Fluorescence-based amplified fragment length polymorphism (fbAFLP) is a novel assay based on the fluorescent analysis of an amplified subset of restriction fragments. The fbAFLP assay involves the selective PCR amplification of restriction fragments from a total digest of genomic DNA. The ligation of adapters with primer-specific sites coupled with primers containing selective nucleotides allowed the full potential of PCR to be realized while maintaining the advantages of restriction endonuclease analysis.

Vancomycin-resistant enterococci.

After they were first identified in the mid-1980s, vancomycin-resistant enterococci (VRE) spread rapidly and became a major problem in many institutions both in Europe and the United States. Since VRE have intrinsic resistance to most of the commonly used antibiotics and the ability to acquire resistance to most of the current available antibiotics, either by mutation or by receipt of foreign genetic material, they have a selective advantage over other microorganisms in the intestinal flora and pose a major therapeutic challenge. The possibility of transfer of vancomycin resistance genes to other gram-positive organisms raises significant concerns about the emergence of vancomycin-resistant Staphylococcus aureus.

Outbreak of vancomycin-resistant enterococci in a burn unit.

Objective: To investigate and control an outbreak of colonization and infection caused by vancomycin-resistant enterococci (VRE) in a burn intensive care unit (BICU).

Design: Epidemiological investigation, including multiple point-prevalence culture surveys of patients and environment, cultures from hands of healthcare workers (HCWs), pulsed-field gel electrophoresis (PFGE) typing of patient and environmental isolates, case-control study, and institution and monitoring of control measures.

Setting: BICU in an 800-bed university medical center in Galveston, Texas.

Comparison of the Vitek GPS-TB card with disk diffusion testing for predicting the susceptibility of enterococci to vancomycin.

Objective: To compare the ability of the Vitek GPS-TB card with disk diffusion testing for determining the susceptibility of enterococci to vancomycin.

Design: Vitek susceptibility testing was performed using the GPS-TB card and software version R05.03.

Risk factors for colonization or infection due to methicillin-resistant Staphylococcus aureus in HIV-positive patients: a retrospective case-control study.

Objective: To determine the risk factors for colonization or infection with methicillin-resistant Staphylococcus aureus in human immunodeficiency virus (HIV)-infected patients.

Design: Retrospective matched-pair case-control study.

Setting: Continuity clinic and inpatient HIV service of a university medical center.

Epidemiology of ventilator-acquired pneumonia based on protected bronchoscopic sampling.

We performed a prospective observational cohort study of the epidemiology and etiology of nosocomial pneumonia in 358 medical ICU patients in two university-affiliated hospitals. Protected bronchoscopic techniques (protected specimen brush and bronchoalveolar lavage) were used for diagnosis to minimize misclassification. Risk factors for ventilator-associated pneumonia were identified using multiple logistic regression analysis.

Nosocomial sinusitis in patients in the medical intensive care unit: a prospective epidemiological study.

A prospective observational cohort study of nosocomial sinusitis was carried out in two medical intensive care units. Sinusitis was diagnosed by computed tomographic scanning and the culture of sinus fluid obtained by puncture of a maxillary sinus. Clinical and epidemiological data were collected at the time of admission to the unit and daily thereafter.

Nosocomial pneumonia. Diagnosis and prevention.

Ventilator-associated pneumonia (VAP) is an important complication in patients with respiratory failure who undergo endotracheal intubation and mechanical ventilation. VAP cannot be accurately diagnosed by clinical or radiographic criteria or culture of endotracheal aspirates; however, it can be accurately diagnosed by histopathologic examination of lung tissue, rapid cavitation of a pulmonary infiltrate, culture of empyema fluid, percutaneous lung needle aspiration, simultaneous recovery of the same microorganism from cultures of respiratory secretions, and blood and quantitative culture of lower respiratory tract secretions obtained by bronchoscopy. VAP can be prevented by proper decontamination and use of ventilatory support equipment, practice of proper nursing techniques during care of the mechanically ventilated patient, and use of face mask ventilation in selected patients.

Characterization and control of intraamniotic infection in an urban teaching hospital.

Objectives: Our purpose was to determine (1) whether risk factors for intraamniotic infection were similar in women delivered of preterm infants versus term infants and (2) whether infection control techniques could decrease the incidence of intrapartum fever on a labor and delivery unit.

Study Design: A total of 5409 consecutive patients (group 1) admitted to the Medical College of Virginia's labor and delivery unit were followed up prospectively to determine the development of intraamniotic infection. Demographic and intrapartum data were collected by use of a standard data form by infection control practitioners.